A practice in the City of Kingston upon Hull area

5. Mr T complains about the care and service he received from a GP Practice in Hull (the Practice) in August and September 2025. He complains the Practice:

• refused access to Mounjaro without clear explanation, and refused to put him back on the bariatric pathway when Mounjaro was rejected

• refused to provide care or onward referrals for back pain

• refused to appropriately manage borderline diabetes through consultations

• would not allow discussion of more than one health condition per appointment, and did not review his health concerns in the round during appointments that were too short

• did not take his blood pressure on 29 August and refused a home visit when it transpired the reading taken later by reception was over 200

• provided an incomplete consultation on 1 September, refused to provide care or treatment, made no onward referrals when his blood pressure moved between 159/104 and 220/120, threatened him with the police, and removed him from the Practice list.

6. Mr T says the significant distress and emotional harm caused by the failure to address urgent clinical needs, means he has lost confidence and trust in the healthcare provided by the Practice.

7. He says that because his health conditions were not considered together, his cardiovascular risk increased, his back condition got worse and his weight loss journey stalled. Because he was removed from the Practice patient list, Mr T says he could not access health care, or his existing medications, for two months.

8. By making the complaint, Mr T would like an honest and meaningful acknowledgement of any failings identified, service improvements around the approach to patients with complex health needs and in how the Practice approaches distressed patients.

9. Mr T is in his 50’s. He has a range of significant health problems. These include borderline diabetes, obesity, high cholesterol, sleep apnoea, and a back injury. Historically, he has also had a triple heart bypass, and a stroke. He remained under the care of the Practice for these issues and others, until September 2025, when the Practice removed him from the patient list.

Mounjaro

13. Mr T says that the Practice provided inaccurate information about his eligibility for weight loss treatment. He complains that bariatric specialists recommended the treatment because he met the criteria, but doctors refused to prescribe it without giving a clear reason.

14. The Practice said that to qualify for this treatment, Mr T would have needed a body mass index (BMI) over 40, and four obesity related conditions. It provided Mr T a link to the eligibility criteria.

15. It said Mr T was discharged from the bariatric pathway in August 2025 because his mental health issues meant he did not meet the criteria for weight loss surgery. Given this, the Practice said it was reluctant to refer him again, without addressing his mental health.

16. We recognise that Mr T does not believe he was given proper detailed reasons for being rejected. The records thoroughly document that he felt weight loss injections would ultimately facilitate back surgery, so we can certainly recognise the importance he placed on obtaining Mounjaro.

17. The Practice provided a directive it had received from the local Area Prescribing Committee (APC) in June 2025. It is explicit in saying that Mounjaro should not be prescribed for obesity at that time, and any ongoing prescriptions should be stopped. This means that regardless of the criteria, or the wishes of other NHS services, the Practice could not prescribe Mounjaro for weight loss.

18. Mr T provided a video consultation in which he and a GP discussed the reasons. The GP was not wholly clear and did keep referring to the criteria unnecessarily. We do think the GP could have communicated more directly that the rejection was all encompassing, though we do also recognise that the GP was attempting to provide Mr T with as much information as possible, and did repeatedly cite funding as the problem. It is clear throughout this recording that communication had broken down.

19. The GP sent Mr T a message following this encounter, containing a link to the local Integrated Care Board’s (ICB) current stance on GP’s prescribing Mounjaro for weight loss. We used archiving web services to review this link. It sets future criteria for eligibility but notes this had not yet happened. It tells patients not to request Mounjaro from their GP for now, because the request will be refused.

20. We were sorry to see that Mr T was unable to access Mounjaro through NHS services in the area. However, we expect GP Practices to follow local guidance where it applies and therefore, we cannot see any indication the Practice was wrong in its rejection.

Back pain

21. Mr T says the Practice refused to refer him to a musculoskeletal specialist (MSK) for his back pain. As a result, his back pain has become worse. He says that his new GP has cleared him for back surgery and placed him on a structured weight management program, which he believes the Practice should have done.

22. The Practice said Mr T could self-refer for backpain and provided a link.

23. The records show that Mr T had back pain, due to disc prolapse that pinched a nerve and caused significant sciatic pain. Mr T was under a local pain management team for nerve blocks to his back, and a neurosurgeon for proposed spinal surgery.

24. NICE Low Back Pain and Sciatica in Over 16s: Assessment and Management (December 2020), and NICE Sciatica (lumbar radiculopathy) Management for over 16’s (January 2025), both direct referrals in various scenarios, but none include MSK and instead apply to the specialisms Mr T was already under or had been under, prior to discharge.

25. The records show that for Mr T to have spinal surgery safely, he needed to lower his body mass index (BMI). He was under the bariatric pathway to achieve this but was discharged in August, because the team wanted him to demonstrate a 12 month history of stable mental health, but thought he had not. The bariatric team advised Mr T that he would need to have his mental health assessed again by his GP before referring him back in. It did not make any onward requests of the GP.

26. On 26 August, the records show that Mr T arranged a consultation to discuss his ongoing back pain. The GP documented a lot of detail about the problem and concluded they would restart a medication Mr T had found effective before. The GP also noted their willingness to refer Mr T back into the weight loss program, but documents that Mr T began to shout and swear, which ultimately ended the consultation.

27. On 29 August, Mr T spoke to the GP about his back pain again. The GP advised they would refer Mr T to the back surgeons once his mental health was sorted. This was 17 days after he had been informed of the same requirement by the bariatric team, with no other documented discussions or actions related to mental health in the interim.

28. On 1 September, Mr T mentioned his back pain again, but this was explicitly in the context of accessing Mounjaro. He made no onward requests. The records document that Mr T felt like he was in a vicious circle because his back pain meant he could not lose weight and because he could not lose weight, he could not have back surgery. We can certainly recognise this problem, but we cannot say it was created by a lack of MSK referral.

29. With no guidance to say that Mr T should have been referred to MSK, and no documented request from Mr T, we cannot see that the Practice should have done anything differently on this occasion.

Diabetes

30. Mr T complains that the Practice would not provide a consultation to discuss his borderline diabetes.

31. The Practice said that Mr T’s borderline diabetes could be managed through diet.

32. NICE Type 2 Diabetes in Adults: Management (December 2015) says that patients should aim for a target Hba1c reading of 58mmol/mol. Once this is achieved, the guidance says that patients should be reassessed annually.

33. On 7 May, the records show that Mr T’s Hba1c results fell below the threshold and staff noted that he required no additional follow up outside of an annual check, in line with the guidance. On 5 August, the Practice invited Mr T for his annual diabetes check.

34. The records show that in relation to diabetes Mr T also received an appointment for retinal screening in November 2024, though he did not attend.

35. On 1 September, the Practice documented Mr T’s diabetic reading in connection to accessing Mounjaro. This too was significantly below the threshold for action set out in the guidance. We cannot see any evidence in the records to suggest Mr T had been refused an appointment for diabetes, or that staff refused to discuss the topic. When we consider the records against the directions set out in national guidance, we are satisfied that nothing went wrong.

Appointment content and duration

36. Mr T complains that the Practice provides 10 minute appointments, for discussion of a singular health issue, which meant the issue being discussed was never considered against the backdrop of his other comorbidities. He says that appointments were also taken up with his medical history due to a lack of continuity with which doctor he saw.

37. He says that attempts to expand the discussion in this way led to GP’s ending appointments prematurely, often in an aggressive tone. He says that these appointments left him without any clear idea of how to access urgent care for any of his comorbidities.

38. The Practice said that it provides 10 minute appointment slots for patients to discuss a single health issue, and 20 minutes if they have two. Further conditions should then be booked through separate appointments. It said this allowed for the safe delivery of health care.

39. The BMA Safe Working in General Practice (March 2025) noted that the average appointment should be around 10 minutes but was at the time encouraging GP’s to increase the time to 15 minutes if their patient load permitted. Though, as of April 2026, the updated guidance has rescinded that extra five minutes.

40. The Practice’s appointment policy, which is available to the public, says that patients receive a 10 minute appointment slot, in line with the BMA. Its policy also says that patients must only discuss one medical problem in each 10 minute slot.

41. On 26 August, we can see that Mr T wanted to discuss two issues. His chronic back pain, and weight loss support. The GP informed Mr T that he would need to book a second appointment for weight loss, because the appointment had already exceeded 20 minutes. This is in line with both the guidance set out by the BMA at the time and the Practice’s own policy.

42. On 1 September, Mr T filmed the consultation, in which he discussed access to Mounjaro, and diabetes management. We saw almost 30 minutes of consultation. The GP left this consultation because Mr T would not.

43. The BMA sets limits for the patient contact a GP can have in a day, to remain safe and maintain a consistent workload. Every breach of the appointment time limit eats into the GP’s contact time with other patients who need help that day. Mr T’s view was at odds with local and national policies, so we could not be critical of the GP for leaving.

44. What happened on 1 September, in Mr T’s final appointment, was not in line with what should have happened. The consultation should not have lasted longer than 10 minutes but exceeded this significantly. The consultation should have covered one issue, but the recording reflects Mr T’s intention to discuss his back pain, diabetes, weight loss, and heart problems. It is our view that the GP was correct to end the consultation, and should have done sooner, to ensure other patients could access their own care. This would have been in line with national and local policy.

45. We acknowledge that Mr T had more to discuss, and that he did not feel heard by Practice staff when he raised these concerns. We can see multiple examples in the records that show Mr T booked an appointment for one issue then wanted to discuss others when the time came. Staff did engage in these other discussions. Had Mr T attempted to raise his health concerns separately, in line with Practice policy then we could be critical of staff for not addressing them. However, Mr T received a more in depth service than what is set out in national and local guidance, so we cannot see any evidence to show that the Practice fell short of what was expected.

Consultation 29 August

46. Mr T says that despite attending with concerns over his blood pressure, the GP did not take his blood pressure. He says reception took a reading for him on his way out, and a GP called him at home because the reading had shown a blood pressure of 225/118. He complains that despite the medical emergency his blood pressure presented, the GP would not see him at home and instead arranged an appointment at another location much further away. He says getting there really worried him.

47. The Practice said the purpose of this appointment was to discuss reported cardiac issues and palpitations, but the GP did not have a working blood pressure cuff in the room so directed Mr T to use the machine in reception.

48. It said Mr T was not housebound and therefore did not qualify for home visits. It said the doctor advised Mr T to attend A&E, but he declined, so the Practice arranged an appointment at a nearby site to try and accommodate him. It also highlighted that the Practice had taken steps to increase his existing medication, and some additional steps GP’s would have taken once the effectiveness of medication increases had been assessed.

49. NICE Hypertension in Adults: Diagnosis and Management (August 2019) gives a target blood pressure reading for Mr T’s age bracket of 140/90. For a standalone high reading, the guidance says a patient should commence regular monitoring and a same day hospital assessment applies to a reading of 220/120 or higher.

50. The records show that Mr T was taking medication for his blood pressure. On 29 August, the records show that Mr T took his own blood pressure in reception, with a result of 228/116. The duty doctor reviewed this, contacted Mr T, and asked him to attend A&E. This action was in line with the guidance, and the records show that Mr T did refuse the advice.

51. The records show Mr T wanted the doctor to take his blood pressure at home. The Practice website sets out the criteria for home visits. It says a patient must be unable to travel or be brought to the Practice due to a serious illness or infirmity. Mr T had attended the Practice already that day, so we can see that he did not qualify for home visitation. Because he declined hospital assessment, the doctor asked him to conduct regular BP monitoring at home, which was the next step down in NICE guidance.

52. Mr T did take his blood pressure at home, with a reading of 219/120. This is one point under the threshold in guidance for same day admission, which Mr T had already declined. The doctor documented that they had asked him to increase his home monitoring. They also increased the dosage of his existing blood pressure medication. Given Mr T would not go to A&E as correctly advised in line with the guidance, we cannot see what else Practice staff could have done. This is also true even in the event a doctor did attend his home address.

53. Mr T’s blood pressure was very high. He tells us that in the past he has suffered a heart attack and a stroke, so we can recognise how worrying these readings must have been for him. We must balance that with Mr T’s responsibility to play a part in his own health and wellbeing, as set out in the NHS Constitution. He has an absolute right to refuse any suggested treatment, such as going to A&E when indicated, but this refusal does not automatically obligate a Practice to take further actions outside of the guidance.

54. When we consider the Practice’s response to Mr T’s blood pressure readings, we are satisfied that it took appropriate action and made the appropriate signposting in line with the guidance.

Consultation 1 September

55. Mr T complains that a GP on 1 September refused to discuss his concerns or take any action when his blood pressure reading was high. He says the GP made him leave the consultation early and threatened to call the police if he refused. He complains the Practice then removed him from its patient list, which left him without care and medication for two months.

56. The Practice said the appointment was to discuss a blood pressure management plan, but on arrival, Mr T had directed the discussion towards Mounjaro. It said the GP reiterated that it was unavailable and offered alternatives, but Mr T would not accept these. It said Mr T began to film staff on his mobile phone and the GP left the room because they felt so uncomfortable. The Practice accept a second doctor told Mr T they would call the police if he did not leave and maintained he this was warranted at the time because he was delaying other patients using the service.

57. Following the consultation, the Practice said it sent Mr T a text message requesting seven days of blood pressure readings in line with national guidance, with a view to creating a management plan.

58. We have established that the Practice took appropriate action when responding to Mr T’s blood pressure readings. We have established that this appointment lasted far longer than it should have, and that in line with Practice policy, the GP should have ended the consultation sooner. We have also established that although the GP could have been clearer, they were correct in telling Mr T that he could not access Mounjaro through the Practice – a decision that rested solely with the local commissioning board. We therefore considered whether it was appropriate for the Practice to have highlighted police involvement, and whether Mr T was removed from the Practice list in line with policy.

59. The Practice Registration and Removal Policy (March 2024) says that if a doctor believes the effective delivery of care has become unachievable due to an irretrievable breakdown in doctor-patient relationship, the patient should be removed from the Practice patient list with eight days notice. The records show that Mr T was removed under this timescale, for this reason.

60. NHS England Primary Medical Services Policy and Guidance Manual (PGM) (September 2025) sets out the specifics of this kind of problem. It says a patient can be removed under this provision if they use offensive language, microaggressions and hostile comments, or make unnecessarily persistent or unrealistic service demands that cause disruption.

61. Mr T’s recording is complete with no breaks and appears to show the entirety of the consultation. He saw two separate doctors, asked about access to Mounjaro 11 times and received an explanation as to funding restrictions nine times.

62. He calls doctors incompetent, and liars. Three times he advises that he is recording the consultation and implies the purpose is to take legal action. Mr T also tells a doctor that he will not leave and welcomed a call to the police instead. He implies a doctor will be directly responsible should he have a heart attack. Whilst we can recognise Mr T’s frustration at the situation, what happened in this recording shows that the patient-doctor relationship had broken down.

63. The Practice policy says it should write to patients removed under the eight-day timescale, explaining the reasons. The records show it sent this letter to Mr T on 15 September. The letter says in August, Mr T shouted and swore at staff, and we can see this in the records. It then details the events of this appointment, which the video recording shows are accurate.

64. When we consider what happened, we are satisfied that the Practice responded to Mr T’s actions in line with local and national policy. It is clearly reflected throughout the records that Mr T did not believe the Practice was providing the best care he could get. Mr T begins the consultation on 1 September advising he has lost faith in staff. Given his concerns, it appears that removing him from the Practice list was in his best interests too. This is particularly true given that he tells us how pleased he is with the care he now receives, having registered elsewhere.

65. Most pertinent to Mr T, we were very pleased to see that as of 1 April 2026, local funding for Mounjaro has now been released. We wish him luck with this endeavour.

66. Mr T has a lot of health problems that naturally must worry him, and we can see that worry reflected throughout the Practice records. It is reasonable to want access to care that is available and could help. It is not reasonable to repeatedly request access to care that is not available, and that lack of availability does not mean that the Practice has withheld care.

67. We have carefully compared what happened against national guidance and local policy and we have seen evidence to show that the two align. Because there are no indications that the Practice acted outside of guidance and policy, we cannot see a good reason to take further action. We recognise that Mr T will likely find our decision frustrating. We hope that our report provides a clear explanation of how we reached this decision.

1. We have carefully considered Mr T’s complaint about a GP practice in the Hull area (the Practice).

2. Mr T has a number of health concerns, and we have seen clear evidence of the worry these caused him. We can appreciate his desire to access all the options available to support his health and wellbeing, as a result.

3. We have seen evidence that shows the Practice has worked within national guidance and local policy, so although Mr T felt an injustice, we have seen no indication that the Practice was responsible.

4. We will therefore take no further action.